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Research Snapshot Theater: Endocrine, Adult and Pediatric

Reducing Hypoglycemia During Treatment of Pediatric DKA via Hospital Guideline Revision

Monday, March 23, 2026
11:30 AM - 12:30 PM Central Time
Location: Connections Central - RST 12
  • AT

    Alise Tracy, PA-C

    Maryland

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • MN

    Maria Eleni Nikita, MD

    Assistant Professor
    University of Maryland School of Medicine

    Disclosure information not submitted.

  • TL

    Thomas Laudone, PharmD, BCPPS

    Pediatric Clinical Pharmacy Specialist- Emergency Medicine
    University of Maryland School of Pharmacy

    Disclosure information not submitted.

  • KP

    Kristine Parbuoni, PharmD, BCPPS

    Associate Professor
    University of Maryland School of Pharmacy

    Disclosure information not submitted.

  • CL

    Cassidy Luke, PharmD, BCPS

    Pediatric Clinical Pharmacy Specialist- PICU/PCICU
    University of Maryland School of Pharmacy

    Disclosure information not submitted.

  • PN

    Paula Newton, MD, MBA

    Assistant Professor
    University of Maryland School of Medicine

    Disclosure information not submitted.

  • SD

    Siddhartha Dante, MD, MHS

    Assistant Professor
    University of Maryland School of Medicine

    Disclosure information not submitted.

Introduction:

Introduction: Diabetic Ketoacidosis (DKA) is a common illness admitted to pediatric intensive care units (PICU). Standard treatment is a continuous intravenous insulin infusion which poses a risk of hypoglycemia. Severe hypoglycemia is associated with increased morbidity and mortality. Our objective was to decrease hypoglycemic events through revisions to the pediatric DKA treatment guidelines.


Methods:

Methods: A multi-disciplinary workgroup revised our institution’s pediatric DKA treatment guidelines with the goal of reducing hypoglycemic events while on an insulin infusion. Changes included adjustment of blood glucose (BG) goals to 150-200 mg/dL (previously 100-150 mg/dL) and early insulin glargine administration with subsequent reduction of insulin infusion from 0.1 U/kg/hr to 0.05 U/kg/hr.

We performed a retrospective chart review of patients admitted to our PICU with the diagnosis of DKA from January 2022- March 2025. The primary outcome of interest was the number of hypoglycemic events, defined as BG less than 70 mg/dL. Balancing measures of interest included time to DKA resolution and hospital length of stay (LOS).


Results:

Results: A total of 120 encounters from 96 patients were included in the analysis (pre-implementation cohort N=76; post implementation cohort N=44). The pre and post cohorts were similar in age and severity of DKA. There were significantly fewer hypoglycemia events in the post implementation cohort (0 (0%) vs 9 (11.8%); p = 0.018) with significantly higher median minimum blood glucose (137.5 (IQR:109.5-173.5) vs 114 mg/dL (IQR:81.5-145)). Time to DKA resolution was increased in the post cohort (14.8 (IQR:11.1-20.2) vs 13.2 hr (IQR:10.0-17.0)) though this was not clinically significant (p= 0.096). Hospital LOS was unchanged (2.75 (IQR:1.66-3.35) vs 2.73 days (IQR:1.36-3.85); p= 0.855)).


Conclusions:

Conclusions: Revision of hospital guidelines for pediatric DKA treatment resulted in a significant reduction in hypoglycemic events without significant change in time to DKA resolution or hospital length of stay. Future work will focus on adopting updated treatment guidelines across the hospital system, including satellite campuses, to ensure consistent DKA treatment.